Indications Level and Outcome of Lower Extremity Amputations in Nnewi, Nigeria

Abstract

To highlight the indication, level of amputation and the problem associated with lower extremity amputations including rehabilitation in this environment and compare them with results from other centers. The setting is Nnamdi Azikiwe University Teaching Hospital Nnewi, and Holy Cross Hospital Nnewi. Hospital records of 46 patients (32 males; 14 females) who had lower extremity amputation between 1st January, 1991 to 31st December, 1996 formed the basis for this study. Information on age, diagnosis, amputation level, wound closure, complications, morbidity, mortality and prosthetic rehabilitation was extracted and analyzed. The mean age was 54.4 + 18 years with a male:female ration of 2.28:1. Fifty amputations were carried out with the indication as Diabetic gangrene (n=21) 45.6%; Trauma (n=9) 19.6%; Idiopathic gangrene (n=8) 17.4%; Malignancy (n=5) 10.9% and chronic leg ulcer (n=3) 6.5%. The commonest amputation level was below knee (n=24), followed by the disarticulation (n=12); Above knee (n=4), Gritti-Stokes (n=4), Knee amputation (disarticulation) (n=3) and trasmetatarsal amputation (n=3). Wound infection occurred in 36.4% wounds closed primarily and in 35.7% of wounds left open to minimize the risk of infection. Wound dehiscence occurred in 8 patients and flap necrosis in 4. A reamputation rate of 16.7% was recorded for below knee amputations. The mortality rate was 15.2%. None of the patients acquired any prosthesis during convalescence. The below knee amputation is the commonest amputation level here and it reflects the low level of vascular disease in this environment. Diabetic gangrene is the main indication for amputation. The wound infection rate, mortality, morbidity and re-amputation levels are comparable with other published works. There is general aversion to prostheses and it is hoped that with the availability of modern prosthesis (instead of wood prosthesis), health education would help to encourage more amputees to accept them.


Key Words: Amputation, Lower Limb, Indications, Level, Complications.


Jnl of Medical Investigation and Practice Vol.2 2001: 18-21